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Preoperative patellar bone marrow lesions with full thickness cartilage defects correlate with residual anterior knee pain in total knee arthroplasty without patellar resurfacing

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Residual anterior knee pain is one of the most common problems after total knee arthroplasty (TKA). However, the contributing factors affecting postoperative anterior knee pain (AKP) remain poorly understood. This study aimed to evaluate the effect of preoperative patellar bone marrow lesions (BMLs) and patellar cartilage defects on postoperative AKP after patellar non-resurfacing TKA.

Methods

This retrospective study included 336 patients who underwent unilateral TKA without patella resurfacing. All patients underwent preoperative magnetic resonance imaging (MRI) to assess the presence of BMLs and the degree of cartilage defects in the patella. Patients were categorized into four groups according to the presence of BMLs (with or without BMLs) and the degree of cartilage defects (with or without full thickness cartilage defects). The Kujala Anterior Knee Pain Scale (AKPS) and the Hospital for Special Surgery Knee Rating Scale (HSS) scores at 2 years after TKA were compared among the groups.

Results

Preoperative BMLs in the patella were found in 132 (39.3%) of 336 cases. Among the four groups, the group with both BMLs and full-thickness cartilage defects demonstrated significantly lower AKPS compared to the other groups at 2 years after TKA (p < 0.01), but no significant difference was shown in the HSS scores, between these groups. There were no significant differences in either AKPS or HSS scores among the other three patient groups.

Conclusions

The presence of preoperative BMLs with full-thickness cartilage defects in the patella was associated with worse postoperative AKP after TKA without patella resurfacing. Patella resurfacing should be considered in this patient group to minimize the risk of developing residual AKP after TKA.

Level of evidence

III.

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Data availability

Not applicable.

Abbreviations

AKP:

Anterior knee pain

AKPS:

Anterior Knee Pain Scale

AP:

Anteroposterior

BMLs:

Bone marrow lesions

BTU:

Bone tracer uptake

FCR:

Femoral component rotation

HSS:

Hospital for Special Surgery Knee-Rating Scale

HTO:

High tibial osteotomy

ICRS:

International Cartilage Repair Society

MCID:

Minimal clinically important difference

MRI:

Magnetic resonance imaging

OA:

Osteoarthritis

PD:

Patellar denervation

SPECT/CT:

Single-photon emission computed tomography/computed tomography

TCR:

Tibial component rotation

TKA:

Total knee arthroplasty

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Acknowledgements

The authors thank the Medical Research Collaborating Centre of Hallym University for the support in statistical analysis. This research was supported by the Hallym University Research Fund 2022 (HURF-2022-36).

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea

    Ho Jung Jung

  2. Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

    Min Wook Kang, Jong Hwa Lee & Joong Il Kim

  3. Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

    Joon Kyu Lee

  4. Department of Orthopedic Surgery, Hallym University Hospital, 1 Singilo, Yeongdeungpo-gu, Seoul, 07441, Korea

    Joong Il Kim

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Contributions

We have included five authors, who contributed significantly to this study. The following is the table listing each author’s contribution. Each of the authors has read and concurs with the content in the final manuscript. HJJ: data curation; formal analysis; investigation; writing—original draft. MWK: data curation; formal analysis; investigation; writing—review and editing. JHL: data curation; formal analysis; investigation; writing—review and editing. JKL: conceptualization; methodology; supervision; validation; writing—review and editing. JIK: conceptualization; methodology; project administration; validation; writing—review and editing.

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Correspondence to Joong Il Kim.

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All authors have no competing interests to declare.

Ethical approval

This study was approved by Hallym University Kangnam Sacred Heart Hospital Institutional Review Board. (no. 2022-10-031) All investigations were conducted in conformity with ethical principles of research.

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Jung Jung, H., Kang, M.W., Lee, J.H. et al. Preoperative patellar bone marrow lesions with full thickness cartilage defects correlate with residual anterior knee pain in total knee arthroplasty without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 31, 5048–5056 (2023). https://doi.org/10.1007/s00167-023-07551-4

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